| NPI | 1255857439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 101YP1600X Counselor Pastoral | |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2024-04-23 |